Incidence and Cost of Veno-Occlusive Disease/Sinusoidal Obstruction Syndrome with and without Multi-Organ Dysfunction: Analysis of the Premier Healthcare Database

Abstract

<h3>Introduction</h3> Hepatic veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) is a potentially fatal complication that occurs after hematopoietic cell transplantation (HCT). The incidence of VOD/SOS post-HCT is estimated to be ∼14% (Coppell JA, et al. <i>BBMT</i>. 2010). A prior study defined severe VOD/SOS as the presence of multi-organ dysfunction (MOD) and reported higher medical costs in patients (pts) with severe VOD/SOS vs. those without. The prior study assessed pts in the Premier Healthcare Database (2009-2014), in the absence of formal diagnostic codes, and reported an incidence of VOD/SOS of 5.3% and 6.3% in adult and pediatric pts, respectively. <h3>Objectives</h3> This study created an algorithm to identify VOD/SOS using diagnosis codes and assessed healthcare resource utilization, costs and outcomes in post-HCT pts with VOD/SOS, with or without MOD, vs. pts with no VOD/SOS. <h3>Methods</h3> This retrospective, observational study included post-HCT pts in the Premier Healthcare Database (2015-2018) with an inpatient hospitalization and ICD-10-CM/PCS, CPT, HCPCS or MS-DRG codes for HCT. VOD/SOS pts were identified using ICD-10-CM diagnosis code K76.5, VOD/SOS-related codes, or use of defibrotide within 90 days of index hospitalization. VOD/SOS pts with codes for MOD in the same hospitalization comprised the VOD/SOS with MOD group. VOD/SOS pts without MOD and pts without VOD/SOS comprised the VOD/SOS without MOD group and no VOD/SOS group, respectively. Total hospital length of stay (LOS) and costs were examined during index hospitalization and 90 days after index discharge. Bivariate analysis was used to study the difference in unadjusted outcomes between post-HCT pts with and without VOD/SOS. Wilcoxon test was used for continuous variables and Chi-square test was used for categorical variables. Adjusted analysis based on multivariable regressions was used to control for pt and hospital characteristics. <h3>Results</h3> The analysis included 4,642 pts (no VOD/SOS: n = 4,352; VOD/SOS with MOD: n = 177; VOD/SOS without MOD: n = 113). Overall, VOD/SOS occurred in 6.2% of pts; 3.8% and 2.4% of pts had VOD/SOS with and without MOD, respectively. VOD/SOS was more common in pediatric (14.3%) than adult (5.7%) pts and in allogeneic (11.4%) vs. autologous HCT (3.5%) pts. After adjustment, total LOS was longer in VOD/SOS pts with and without MOD vs. no VOD/SOS (Table). Total costs and inpatient mortality were higher in VOD/SOS pts with MOD vs. no VOD/SOS. The 90-day all-cause readmission rates were not different across groups. <h3>Conclusion</h3> The results were consistent with VOD/SOS rates reported in the literature. The slightly higher rate of VOD/SOS reported here vs. a prior study was driven by higher incidences in pediatric and allogeneic populations. VOD/SOS, especially with MOD, in post-HCT pts was associated with increased healthcare resource utilization, LOS, and costs vs. HCT pts without VOD/SOS.